1/29. A new approach to an old problem.A patient with progressive visual loss was found to have an optic nerve sheath meningioma. The patient was treated with stereotactic radiotherapy, a computer-guided stereotactic technique that minimizes the risk of radiation-induced optic neuropathy. Six months after treatment, the patient was doing well and showed no signs of radiation-induced optic neuropathy.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
2/29. Melanocytoma of the left optic nerve head and right retrobulbar optic neuropathy compressed by a tuberculum sellae meningioma.A 40-year-old woman had a highly pigmented, slightly elevated tumor on the left optic disc. She had no visual disturbance in the left eye. The tumor was stationary for 5 years. At age 45 years, she complained of decreased visual acuity in the right eye. magnetic resonance imaging showed a right-shifted homogeneous lesion at the tuberculum sellae. Histopathologic study of the excised lesion revealed interlacing bundles of spindle-shaped fibroblast-like cells with whorl formation. We believe that a relationship between melanocytoma of the optic nerve head and a tuberculum sellae meningioma may exist rather than a chance occurrence, as previously suggested by others.- - - - - - - - - - ranking = 5keywords = meningioma (Clic here for more details about this article) |
3/29. Treatment of optic nerve sheath meningioma with three-dimensional conformal radiation.PURPOSE: To report a patient recovering vision after three-dimensional conformal radiotherapy for optic nerve sheath meningioma. methods: radiotherapy was delivered by a three-dimensional conformal technique in 28-180-cGy fractions. RESULTS: visual acuity improved from 20/200 to 20/30, and the visual field defect resolved. CONCLUSION: Visual loss from optic nerve sheath meningioma can be reversed by three-dimensional conformal radiotherapy.- - - - - - - - - - ranking = 6keywords = meningioma (Clic here for more details about this article) |
4/29. Orbital color Doppler imaging of optic nerve tumors.OBJECTIVE: To report changes in retinal arterial and venous blood flow pattern in two patients with tumors involving the entire optic nerve. methods: Retrospective review of one patient with clinical and neuroimaging characteristics typical of bilateral optic nerve gliomas and one patient with a probable meningioma of the left optic nerve sheath. RESULTS: The optic nerve glioma patient had reduced peak systolic velocity of central retinal arteries bilaterally, while the patient with an optic nerve sheath meningioma had relatively low central retinal artery flow velocity and intermittent blood flow in the central retinal vein on the affected side. CONCLUSIONS: Reduced retinal arterial flow velocities in the setting of optic nerve gliomas may correlate with the presence of optic nerve disease. Phasic blood flow in the central retinal vein with optic nerve sheath meningioma may be the reason that some patients with this tumor develop retinal choroidal venous anastomoses.- - - - - - - - - - ranking = 3keywords = meningioma (Clic here for more details about this article) |
5/29. Disk edema and cranial MRI optic nerve enhancement: how long is too long?A 43-year-old woman presented with painful visual loss and optic disk edema in the right eye (OD) diagnosed as optic neuritis. Initial non-gadolinium-enhanced fat suppressed cranial magnetic resonance imaging (MRI) was normal. Three months later, the disk edema persisted and a gadolinium-enhanced MRI scan of the brain and orbits with fat suppression showed enhancement of the optic nerve OD, most consistent with an optic nerve sheath meningioma. The diagnostic difference between optic neuritis and optic nerve sheath meningioma is discussed.- - - - - - - - - - ranking = 2keywords = meningioma (Clic here for more details about this article) |
6/29. Caught by a masquerade: sclerosing orbital inflammation.Idiopathic sclerosing inflammation of the orbit is a distinct form of orbital inflammatory disease characterized by slow and relentless involvement of orbital structures. It is this insidious and relentless course that makes distinction from neoplastic lesions clinically difficult. We report the case of a patient with a several-week history of headache and decreased vision that was originally thought to represent an optic nerve sheath meningioma, based on clinical and radiographic evaluation. Subsequent histopathology from an optic nerve biopsy, however, was more consistent with optic nerve glioma. Eventually, pathologic examination of whole sections through the optic nerve was required to establish and confirm the actual diagnosis of sclerosing orbital inflammation.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
7/29. Optic nerve sheath meningiomas: visual improvement after stereotactic radiotherapy.OBJECTIVE: The management of primary optic nerve sheath meningioma (ONSM) is controversial. Surgery often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option for most patients. When these tumors are left untreated, however, progressive visual impairment ensues, which also leads to blindness. Recently, radiation therapy has gained wider acceptance in the treatment of these lesions. Experience with stereotactic radiotherapy (SRT) in the treatment of ONSMs is limited because of the rare incidence of this tumor. We present a series of patients with ONSM who were treated with SRT. methods: Five patients (three women, two men), ranging in age from 40 to 73 years, presented with progressive visual loss with decreased visual field, visual acuity, and color vision affecting six eyes (one patient had tumor involving both optic nerves). One patient also presented with proptosis and diplopia. Five eyes had functional residual vision (range, 20/20 to 20/40), and one eye was completely blind. All five patients were diagnosed clinically and radiographically to have an ONSM. Three were intraorbital, one was intracanalicular as well as intraorbital, and one was a left ONSM extending through the optic foramen into the intracranial space and involving the right optic nerve. The five functional eyes were treated with SRT by use of 1.8-Gy fractions to a cumulative dose of 45 to 54 Gy. RESULTS: Follow-up ranged from 1 to 7 years, and serial magnetic resonance imaging revealed no changes in the size of the tumor in all five patients. Four patients experienced dramatic improvement in visual acuity, visual field, and color vision within 3 months after SRT. One patient remained stable without evidence of visual deterioration or disease progression. None had radiation-induced optic neuropathy. CONCLUSION: SRT may be a viable option for treatment of primary ONSM in patients with documented progressive visual deterioration, and it may be effective in improving or stabilizing remaining functional vision.- - - - - - - - - - ranking = 5.2298493065601keywords = meningioma, meningiomas (Clic here for more details about this article) |
8/29. Necrotizing neurosarcoidosis masquerading as a left optic nerve meningioma: case report.Isolated neurosarcoidosis involving the optic nerve meninges is extremely rare and is often indistinguishable from a meningioma in its anatomic site and MR imaging presentation. Characteristic findings include enhanced perineural encasement and thickening of the affected optic nerve on contrast-enhanced T1-weighted cranial MR imaging studies. We present the case report of a patient with isolated necrotizing neurosarcoidosis of the left optic nerve, with clinical and MR imaging findings strongly suggestive of a preoperative diagnosis of a meningioma.- - - - - - - - - - ranking = 6keywords = meningioma (Clic here for more details about this article) |
9/29. Fractionated stereotactic radiotherapy for the treatment of optic nerve sheath meningiomas: preliminary observations of 33 optic nerves in 30 patients with historical comparison to observation with or without prior surgery.OBJECTIVE: We investigated the safety and efficacy of stereotactic radiotherapy as an alternative therapy to surgical resection for optic nerve sheath meningiomas (ONSMs). methods: Thirty patients and 33 optic nerves with ONSMs were treated with conventional fractionated stereotactic radiotherapy treatment (CF-SRT) between July 1996 and May 2001 with the use of a 6-MeV LINAC designed for and dedicated to radiosurgery. The LINAC technique involved daily CF-SRT involving a relocatable frame, an average of three isocenters, and high-radiation dose conformality established by noncoplanar arc beam shaping and differential beam weighting. The patients who were treated with CF-SRT were followed clinically with serial visual fields and radiographically with both magnetic resonance imaging and functional (111)In-octreotide single-photon emission computed tomography. The results of treatment were compared with a historical control group of ONSM patients who were either observed or treated surgically and then observed. RESULTS: Our study population comprised 18 women and 12 men with a median age of 44 years (age range, 20-76 yr). The median isosurface radiation dose was 51 Gy (dose range, 50-54.0 Gy), and the median clinical follow-up time was 89 weeks (range, 9-284 wk). Of 22 optic nerves with vision before CF-SRT, 20 nerves (92%) demonstrated preserved vision, and 42% manifested improvement in visual acuity and/or visual field at follow-up. Comparison of our patients with a historical control group revealed preserved vision in only 16% of patients in a comparable period of observation, along with a 150% greater probability of visual improvement. Four patients (13%) had posttreatment morbidities, including visual loss (two patients), optic neuritis (one patient), and transient orbital pain (one patient). On magnetic resonance imaging studies, there was no evidence of tumor progression or recurrence in all patients, including tumor volume reductions noted in four patients. All six patients monitored with (111)In-octreotide scintigraphy demonstrated significant decreases in tumor activity after CF-SRT. CONCLUSION: To date, this article describes the largest reported series of ONSMs. Although longer follow-up is necessary, we think that CF-SRT represents a safe alternative to surgery and offers a higher likelihood of preserved or improved vision in patients with ONSM. Our analysis suggests that CF-SRT is also preferable to observation. Functional (111)In-octreotide single-photon emission computed tomographic scintigraphy provides a useful technique for the assessment of tumor control that complements serial posttreatment magnetic resonance imaging in patients with ONSMs.- - - - - - - - - - ranking = 5.2873116332001keywords = meningioma, meningiomas (Clic here for more details about this article) |
10/29. Multimodality cranial image fusion using external markers applied via a vacuum mouthpiece and a case report.PURPOSE: To present a simple and precise method of combining functional information of cranial SPECT and PET images with CT and MRI, in any combination. MATERIAL AND methods: Imaging is performed with a hockey mask-like reference frame with image modality-specific markers in precisely defined positions. This frame is reproducibly connected to the VBH vacuum mouthpiece, granting objectively identical repositioning of the frame with respect to the cranium. Using these markers, the desired 3-D imaging modalities can then be manually or automatically registered. This information can be used for diagnosis, treatment planning, and evaluation of follow-up, while the same vacuum mouthpiece allows precisely reproducible stereotactic head fixation during radiotherapy. RESULTS: 244 CT and MR data sets of 49 patients were registered to a root square mean error (RSME) of 0.9 mm (mean). 64 SPECT-CT fusions on 18 of these patients gave an RMSE of 1.4 mm, and 40 PET-CT data sets of eight patients were registered to 1.3 mm. An example of the method is given by means of a case report of a 52-year-old patient with bilateral optic nerve meningioma. CONCLUSION: This technique is a simple, objective and accurate registration tool to combine diagnosis, treatment planning, treatment, and follow-up, all via an individualized vacuum mouthpiece. Especially for low-resolution PET and even more so for some very diffuse SPECT data sets, activity can now be accurately correlated to anatomic structures.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
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